Healthcare Provider Details

I. General information

NPI: 1003162702
Provider Name (Legal Business Name): SYDNEY LYNN ARNOLD APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SYDNEY LYNN HENKE APRN

II. Dates (important events)

Enumeration Date: 07/31/2012
Last Update Date: 07/31/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 N. FULLERTON
PRONCETON MO
64673-1418
US

IV. Provider business mailing address

400 N. FULLERTON
PRONCETON MO
64673-1418
US

V. Phone/Fax

Practice location:
  • Phone: 660-748-4040
  • Fax: 660-748-4020
Mailing address:
  • Phone: 660-748-4040
  • Fax: 660-748-4020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2012022609
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: